- 期刊
Sequential Bilateral Spontaneous Pneumothorax Following Gefitinib Therapy for Pulmonary Adenocarcinoma with Activated EGFR Mutation-A Case Report
肺腺癌經標靶治療後引起之相繼的雙側自發性氣胸：一病例報告
摘要
雙側自發性氣胸不論是在原發性或轉移性肺腫瘤都是非常少見的，特別是在使用艾瑞莎（Iressa®）治療肺腺癌後發生的自發性氣胸在文獻上更是罕見。艾瑞莎已證實對肺腺癌且上皮細胞生長因子接受體突變陽性的患者有療效。本文描述一名49歲女性患有原發性肺腺癌合併雙側肺部、腦部及全身多處骨頭轉移，且上皮細胞生長因子接受體突變為陽性，在使用艾瑞莎來當做一線治療後，發生相繼的雙側自發性氣胸。肋膜下肺腫瘤壞死併發支氣管肋膜瘻管被認為是氣胸的主因。這個理論與肉瘤及生殖細胞腫瘤經化學治療後發生氣胸的理論相似。氣胸經胸管引流後症狀解除，但是移除胸管後又再次復發氣胸。經後續執行肋膜沾黏治療後便不再發生氣胸。此病例提醒臨床醫師，在使用艾瑞莎治療肺腺癌患者後產生的自發性氣胸是罕見的，若發生時應執行肋膜沾黏治療以避免復發。
並列摘要
Spontaneous pneumothorax (SP) is a rare phenomenon in patients with primary and metastatic pulmonary neoplasm. Gefitinib has been approved as an effective treatment for pulmonary adenocarcinoma patients with an activated epidermal growth factor receptor (EGFR) mutation. Pneumothorax following gefitinib treatment is rarely reported in the literature. We present the case of a 49-year-old woman with primary pulmonary adenocarcinoma with bilateral lung, brain and multiple bone metastases. A L858R point mutation in exon 21 was detected by PCR/direct sequencing. She took gefitinib as her firstline chemotherapy, and had a partial response. Sequential bilateral SP developed after gefitinib had been used for about 2 months. We believe that the SP was caused by gefitinib therapy, which may have resulted in the necrosis of multiple pleural-based pulmonary nodules with bronchopleural fistula formation. This hypothesis is similar to that of SP following cytotoxic chemotherapy in sarcoma and germ cell tumor. We inserted a chest tube, but recurrence was found after its removal. Chemical pleurodesis was used, after which, the SP was no longer noted. In this report, we present a case of bilateral SP, which is a rare complication following gefitinib treatment for pulmonary adenocarcinoma. Chemical pleurodesis is recommended after the lung has been fully re-expanded to prevent repeated pneumothorax.
延伸閱讀
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